How To Use CPT Code 28455

CPT 28455 describes the treatment of a tarsal bone fracture (excluding the talus and calcaneus) with manipulation. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 28455?

CPT 28455 can be used to describe the treatment of a tarsal bone fracture (excluding the talus and calcaneus) with manipulation. This code is used when a healthcare provider performs closed treatment of a fracture in one of the seven tarsal bones located in the midfoot and rearfoot area. The treatment includes the adjustment or manipulation of the fractured bone to restore proper alignment.

2. Official Description

The official description of CPT code 28455 is: ‘Treatment of tarsal bone fracture (except talus and calcaneus); with manipulation, each.’

3. Procedure

1. The healthcare provider prepares the patient and administers anesthesia if necessary.
2. The provider then manipulates or adjusts the fractured tarsal bone to restore proper alignment.
3. After the manipulation, the provider immobilizes the ankle by placing it in a cast or brace for a period of four to six weeks.
4. An X-ray examination may be performed separately to confirm the reduction of the fracture.

4. Qualifying circumstances

CPT 28455 is used for the treatment of a tarsal bone fracture (excluding the talus and calcaneus) that requires manipulation. The patient must have a fracture in one of the seven tarsal bones located in the midfoot and rearfoot area. The treatment involves the adjustment or manipulation of the fractured bone to restore proper alignment. Anesthesia may be administered if necessary, and the ankle is immobilized with a cast or brace for a period of four to six weeks.

5. When to use CPT code 28455

CPT code 28455 should be used when a healthcare provider performs closed treatment of a tarsal bone fracture (excluding the talus and calcaneus) with manipulation. This code is appropriate when the provider adjusts the fractured bone to restore proper alignment. It should be reported for each tarsal bone fracture treated by the provider.

6. Documentation requirements

To support a claim for CPT 28455, the healthcare provider must document the following information:

• Diagnosis of the tarsal bone fracture
• Details of the manipulation or adjustment performed
• Type of immobilization used (cast or brace)
• Duration of immobilization (four to six weeks)
• Confirmation of reduction of the fracture through an X-ray examination, if performed

7. Billing guidelines

When billing for CPT 28455, ensure that the treatment involves the manipulation of a tarsal bone fracture (excluding the talus and calcaneus). The code should be reported for each tarsal bone fracture treated by the provider. If an X-ray examination is performed separately to confirm the reduction of the fracture, it should be reported with the appropriate code. It is important to follow the specific guidelines provided by the payer and use the appropriate modifiers if necessary.

8. Historical information

CPT 28455 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A healthcare provider performs closed treatment with manipulation for a fracture in the navicular bone of a patient’s foot.
2. A patient presents with a fractured cuboid bone, and the provider performs closed treatment with manipulation to restore proper alignment.
3. A healthcare provider treats a patient with a fractured medial cuneiform bone by performing closed treatment with manipulation.
4. A patient sustains a fracture in the intermediate cuneiform bone, and the provider performs closed treatment with manipulation to realign the bone.
5. A healthcare provider treats a patient with a fractured lateral cuneiform bone by performing closed treatment with manipulation.